Martin Candinas discussing
echo interview, January 2023

Politicians need to get a handle on rising healthcare costs


echo interview with Martin Candinas

echo interview with Martin Candinas, Die Mitte, Switzerland’s President of the National Council 2022/2023

elipsLife echo: Mr Candinas, congratulations on your presidency of the National Council. What issues will be front of mind for you during your term in office?
Martin Candinas:
Switzerland is a fascinating country with four national languages and different regions and cultures. It’s hugely diverse and yet unified at the same time. Addressing this complexity is a matter close to my heart. As a Rhaeto-Romanic, I believe strongly in living the four national languages because our great diversity calls for solutions acceptable to all. As President of the National Council, I’ve therefore chosen the motto "zusammen, ensemble, insieme, ensemen”. The emergence and development of our country as a direct democracy, based as it is on finding sustainable solutions, is therefore of crucial significance as far as I’m concerned.

What do you see as the biggest political challenges in the new year?
Certainly energy policy. Russia's war of aggression and general economic and security policy developments are forcing us to think more about how we can ensure that existing and future policy measures retain their effectiveness. Parliament made its first decisions last year, and more will follow. We need to boost our domestic electricity production generally and reduce dependence on energy from abroad. In addition, we’re confronted with serious security policy issues, the BVG, healthcare costs and health insurance premiums. Our relationship with the EU is another topic facing parliament this year.

What challenges does the office of President of the National Council present for you personally?
As President of the National Council, I chair the meetings and represent the Council to the outside world. I’ll pay particular attention to upholding a culture of mutual respect and civilised political debate based upon it – especially in this election year. The other side of the coin for me is the partial renunciation of politics, so to speak. As President of the National Council, I need to keep my opinion to myself and not participate, for example, in debates and panel discussions. Anyone who knows me realises how difficult this will be for me! I’m nevertheless very much looking forward to the office.

Martin Candinas explaining with hand

As a social security specialist, you’re familiar with the health system. Health costs have been rising for years. Neither doctors, hospitals, health insurers nor politicians seem to be especially interested in solving the problem. Who actually does have an interest in reducing health costs?
The people do. Not least because of the massive round of premium hikes last October. Swiss citizens expect their politicians to take effective counter measures. Of course, all the players in the system are in it for their own interests. While an actual cost reduction seems unrealistic, politicians are nevertheless duty-bound to come up with ways to at least get a handle on rising healthcare costs. It’s important to get the various players around the table. After all, experts believe that billions of francs could be saved in the Swiss healthcare system without compromising on quality. We pay much more for most medicines than other countries. And due to flawed financial incentives, many treatments are carried out on an inpatient rather than an outpatient basis.

You say that the population has an interest in lower health care costs. But as soon as premium payers become patients, the will to save weakens. Nobody wants savings to be made at their expense. Do you see a way out of this dilemma?
In principle, no one has an interest in spiralling health care costs, neither service providers nor patients. We’ve got to make sure we continue to have the best healthcare system in the world. We need to remedy what isn’t working in in the system today. Costs are a central factor and health insurance premiums are a reflection of the costs we all incur. When we talk about solidarity, all of us have to do our bit. We need to convince people to use only those services that are really necessary.

Talking about costs in the health system, there’s often talk of misaligned incentives. Can you explain?
One misaligned incentive affects inpatient treatment. In such cases, health insurers pay about one half with the cantons taking on the other half. In the case of outpatient treatment on the other hand, health insurance pays for everything. In this way, of course, the incentive isn’t equally high to carry out the treatment on an outpatient basis and thus more cost effectively. This is a misaligned incentive and should be corrected.

Politicians react with premium reductions and use taxpayers' money for this. Is this the right way or are artificially reduced premiums also a false incentive?
For me, the premium reduction system is the right way to go. People who live in modest economic circumstances benefit from the premium reductions. Their financial burden is lightened, which creates a certain social balance. It’s the cantons’ job to address this issue since the systems employed vary from canton to canton. 

Martin Candinas discussing

It isn’t only the premium payers, but also the KTG and BVG insurers that are confronted with constantly rising health costs. Mental illnesses are a major factor here, especially depression, colloquially known as burnout. Are the follow-up costs of mental overload in the workplace getting out of hand?
These costs are indeed rising. The question is what kind of preventative measures individual companies can take. They, too, need to come up with solutions to prevent burnout among their employees, not just the politicians. If you compare the costs of prevention with the costs of the long-term consequences of mental overload, it’s certainly money well spent. So, I’d appeal both to the corporate sector and to the insurance companies to invest more in prevention.

By affirming the AHV 21 pension reform, the electorate has put the financing of the 1st pillar on a secure footing for the next 10 years. Where do you see the next reform steps for the AHV?
I’m very relieved that the voters have approved this reform and that we’ve finally taken a step forward after more than 25 years. We need to be aware of this fact when negotiating the next adjustments to the AHV. It’ll be important to create incentives to keep people in the labour force longer. This also applies to the level of BVG deductions, which today makes it less than attractive to employ older people. Many individuals in our country would like to work beyond the age of 65 if they could. But the corporate and public sectors frequently don’t offer this possibility. I expect a re-think here on the part of the business associations and increased efforts on how we can keep good workers employed longer. This is especially important at a time when everyone is complaining about a shortage of skilled workers.  

The occupational pension system, BVG, is also due for reform. The Federal Council's proposal with the social partner compromise didn’t stand a chance in the National Council. The Council of States favors a variant taking more account of people with low incomes and part-time jobs. Which model do you prefer?
Parliament has to find a solution that’s acceptable to the majority and, in the BVG context, to improve the situation of part-time employees and those with more than one job. It’s as clear as day to everyone that the conversion rate must be lowered. If this reduction happens, adjustments will be needed for part-time jobs and low salaries that are poorly insured or not insured at all. This affects women in particular. We need to find a balance between the adjustment of the conversion rate, on the one hand, and the adjustment of the coordination deduction and the entry threshold on the other. Provided we succeed in this effort, we’ll be able to improve the situation of part-time workers and help them pay into the pension fund. I have the utmost confidence that parliament will find a workable solution this year. 

How high must the retirement age be to ensure the AHV and pension funds are on a sound financial footing in the long term? 
There’s a mathematical answer, but also a political one. If you analyse the last vote, it seems clear to me that hardly any major adjustments will be possible in the next few years regarding the pension age of 65. As a solution-oriented politician, I would aim for more employees to put the AHV pension age of 65 to one side, to stay longer in the workforce and thus postpone retirement. other words, more flexibility in the retirement age?
Yes, more flexibility. Flexibility in this context is a somewhat dangerous term, because it’s often construed as lowering the retirement age. Here, I see the term more in the sense of "creating incentives" to stay longer in the workforce. This is more beneficial for the AHV, while early retirement is a burden on the system.

Personal Profile
Martina Candinas
Switzerland’s President of the National Council 2022/23

President of the National Council 2022/23, Martin Candinas was born in Ilanz in 1980. He graduated from the Cantonal School of Chur with a type E Matura and trained as a social insurance specialist at the Fachschule Südostschweiz in Chur. His professional career is closely linked to Helsana Versicherungen AG, where he has held various positions since 2001. Candinas has been a member of the National Council for the Die Mitte party since 2011. In the canton of Graubünden, he presides over various associations and is a member of numerous regional foundation councils and party committees. At the national level, Candinas is president of LITRA, the information service for public transport.

echo interview with Martin Candinas